red hair…don’t care.

I got the “red hair…don’t care” award from my residents a couple years ago.  I loved it.  They decided this award was best for me because I shoot pretty straight on most things; especially when it comes to the residents and medical students I work with.  I say things like “here’s a great way NOT to impress your attending.”  Or  “how about we try not to say that in front of the patient.”   I also have a thousand funny memes and sayings and have been known to let loose with my sarcasm at times.

In the spirit of all things “don’t care” I thought I would share with you what myself and my fellow OBGYN’s don’t care about that our patients seem to be all worked up over.

That your legs are not shaved.  No seriously.  I’m not giving you a leg massage.  It really doesn’t bother us.  We usually don’t even notice unless you bring it up.  Confession: our legs probably aren’t freshly shaved either since most of us prefer to use that extra few minutes for sleep instead of time in the shower.

That you are on your period.  I’m sure you hate it but we signed up to deal with it.  Like every day.  Remember we deliver babies and perform surgeries and see hundreds of women who are bleeding.  We got this.  Thanks for worrying about us but we will be fine.

That your socks don’t match or your toes aren’t manicured or you aren’t wearing your cutest undies.  For the most part we get dressed in the dark.  We come into the hospital in the middle of the night.  Our socks might not match.  Wearing underwear is considered enough.  Please do wear it.  You don’t have to wad it up and hide it from us under your other clothes, we don’t care what it looks like.

That you might see me in public.  One time I saw someone bolting down the aisle at Target to avoid me.  It’s OK if you see us at the grocery store or the gym or the PTO meeting (who am I kidding we are always at work during the PTO meetings) we will do our best to remember your name correctly and say hello but it won’t be awkward for us because we take very seriously protecting your privacy and honestly we don’t remember every detail from every patient…that’s why we take good notes!

That you have a ‘weird’ question.  Trust me.  Patients often say “I have a weird question” followed by something that is totally normal/common/not weird at all.  There is not much we haven’t seen or heard.  Not much we haven’t dealt with, walked patients through or bailed someone out of.  What might seem weird to you is probably routine for us.  So hit us up with your ‘weird’ questions.

What the internet (or your bestie) told you.  If you come to the doctor with a plan in place for yourself then it makes our job harder.  Instead of focusing on listening to your problem and making decisions on the best available evidence we spend time re-educating you about what you have read or heard.  We are happy to provide you with that information but we really want to spend our time helping you get better.

So, here’s what we DO care about.

That you are honest with us.  We can’t take care of you if we don’t know what is really going on.  While most OBGYN’s are friendly and inquisitive by nature, we ask about who you are sleeping with and what medications you are taking because we want you to be safe and healthy, not just because we are nosy.

That you know we want what’s best for you.  If you are honest with us we will listen, we will empathize and we will be honest with you.  Sometimes that means we might tell you something that is hard to hear.  Or give you bad news.  But through it all we are doing are best to do what is best….for you.  For your health and for your family.  Try to remember that when the answer we give you isn’t necessarily what you wanted to hear or involves hard work.  We want you to be safe so we are going to ask about any history of violence or dangerous behavior.  We want you to be healthy so we are going to ask you about your diet and exercise habits.  We don’t want to harm you so we might not be able to give you a medication you want or perform a procedure you would like to have.

That you know we are doing our best.   Sometimes we run behind, we get stuck at the hospital or are dealing with a difficult situation.  I can’t promise you won’t have to wait in our waiting rooms or that your surgery won’t be delayed or even that everything will turn out perfect, but know that we are doing our best to make sure you are taken care of as best we can.  We are mothers, fathers, husbands, wives and most importantly, human beings.

screen-shot-2016-09-25-at-6-38-08-pmSo there you have it.  The truth from blonde covering gray hair who don’t care and will tell you how it is.  Go ahead, don’t shave your legs. (Please note that my obgyn friends do ask that you please have clean feet when you arrive.)  Ask the embarrassing question without even saying it’s ‘weird’.  Say hello when you see us at the grocery store with our screaming children and sweat pants. And come to your physician with honesty and an open mind.  Grace and peace, friends!

 

control. period.

A tough thing to come to terms with as an adult is how little control we have over life.  Growing up we can’t wait to be in charge of our lives.  Then you become an adult and realize that there is very little you can control.  Today’s blog is about taking control back from your uterus…and your ovaries for that matter.   Hang on kids, this one’s not for the faint of heart.

I have control issues.  The more things I think I’m in charge of the better I feel.  Seriously.  I blame my parents.  (Just kidding mom and dad!)  I’ve been this way since I was small.  Trying to be in control of what I wore, what my older brother did, where we went when…sounds amazingly wonderful for my parents right?  This is why I was the LAST child.  Well one of my favorite things about my job is giving women control over their lives and their bodies.  If you haven’t heard the news ladies, your reproductive system is working hard most of your life just to do that…reproduce.  And that means a wonderfully complex rollercoaster of hormonal shifts resulting in either pregnancy or a menstrual bleed.  Really?  These are my options.  Awesome.

Humans have been trying to prevent pregnancy since at least the 1500’s.  I won’t drag you through the remote history of attempts at contraception but just know that it involves the use of alligator dung, fish bladders, mercury ingestion and more.  The first commercially available oral contraceptive was available around 1960.  In the 50 years since it has become illegal to advertise or have any public information distributed regarding contraception.   It was available to married couples only.  In fact, it wasn’t until 1972 that birth control became legal for everyone in the US.  Contraception as we know it, with many safe and reliable choices, is a reality that only came into existence in the 1980’s.  To recount all this is fascinating to me.  I have a dozen handouts and booklets on contraceptive options for my patients.  It is difficult if not impossible for me to imagine a reality where I wouldn’t have a choice in, if and when I wanted to become pregnant.  Not to mention no control overScreen Shot 2016-08-25 at 10.08.42 PM my own menstrual cycle or the multiple medical conditions that hormonal contraception is used to control and improve.  A world without hormonal contraceptive options for me is like a world without the internet on a handheld device for the pastor.  Disastrous.

When the pill first became publicly available most women requested it for menstrual regularity.  In fact, many packages had a warning label about the medications “contraceptive side effects.”  But a woman could go to her doctor and ask for the pill for these reasons and then use the medication to safely and appropriately space her family.  Using a hormonal contraceptive for a non-contraceptive indication is quite common these days.  In other words, a lot of my patients come wanting relief from their pain or anemia associated with monthly menses, improvement in their skin from excess androgens and relief from symptoms of things like endometriosis, polycystic ovarian syndrome and others.  Do some of these women use hormonal contraception to prevent pregnancy?  Yes. But some simply use it for these other reasons.  To take control away from their uterus and back into their own hands so to speak.

What most people don’t realize is that you can use the birth control pill and other hormonal methods to completely suppress their period.  No seriously, you can.  And guess what?  It’s safe to do so.  If you ask a room full of female gynecologists who aren’t actively trying to get pregnant if any of them are having regular cycles know what you’ll get?  Crickets.  We avoid periods like the plague.  Why?  Because they are disruptive.  And annoying.  And messy.  Do hormonal contraceptives have risks?  Yes, but these are small compared to the risks of having a baby.  Is hormonal contraception right for everyone? No.  But multiple studies and multiple systematic reviews of those studies have shown extended use of contraception to suppress the menstrual cycle to be no more risky than the usual use of the pill.  Oh yes, and they found that patients were happier not having their period come every month.  Shocking, I know.  When the pill was created it was supposed to mimic a regular cycle so that no one would know you were on the pill.  Sneaky, huh?  Well now every magazine you pick up contains some advertisement for birth control or tampons or something associated with your reproductive organs.  And while we still live in a culture where we raise a fuss about who is having sex with whom (well except for our own kids who would never do such a thing), we have come to terms a bit more with discussing issues surrounding reproduction.  We still have to fight battles for access to affordable and reliable contraception in a country where almost half of pregnancies are unintended.  Sex education in our culture is informal and erroneous at best which propigates most of those unintended pregnancies in both the young and the not so young. But thanks to those who have gone before and paved the way for us to make choices about our own body.  Seriously people.  Someone had to protest for me to gain control over my reproductive organs.  This is the world we live in.

So there you have it.  There are lots of things you can’t control.  What time the baby will deliver.  If your kids will behave in the restaurant.  My work schedule.  How many people will need to talk with Pastor Jason after church.  But fear not.  The menstrual cycle can be controlled.  Don’t want to have a period?   Don’t have to.  Don’t want another baby?  Don’t have to.  Don’t want to be bothered by anovulation or cramps or worsening of some other problem…don’t have to.  You can control at least one part of your life.  period.

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get over it. period.

If you know me, you know that I am full of opinions and strong feelings.  Some of them are about “important things” like atonement theories, HPV vaccination, standing up for victims of abuse.  Most of them are about the “not important” things like what crust you should get on your pizza, naming your baby something that you know how to spell, wearing appropriate shoes for your outfit.  I buy clothes fairly swiftly because I know exactly what I like.  If you ask me to pick something for dinner I might not know what I want, but I will certainly tell you what I absolutely don’t want to eat.  When I picked out furniture for my home a few years ago I told the guy what he had picked that was atrocious and what was fine and he went from there.  I’ve been this way since I was small; my mother spent her mornings struggling to get me into a dress that was “too itchy” “too tight in the neck” or “just didn’t feel right.”  I would eat rice for dinner because nothing else was acceptable.  When my youngest tells me she knows best and I should stop helping her or telling her what to do my mother just smiles and I know that this is exactly what she went through.  I think many of us have stuff we feel strongly about.  One of my practice partners hates all white condiments, grammar errors, giant baby hair bows and spray tans. (love me some spray tan for my ultra-whiteness).

When does my “stop helping me, I know best” voice come through the strongest?  When I’m tired, when I’m stressed, when I’m hungry.  Oh, and when I was pregnant.  Ask any of my work friends about the day prior and the day I went into labor with each of my daughters.  I was full of opinions and strong feelings.  Most of them involved making a plan to fatally injure who I felt were the most annoying among my co-workers.  Yes, that’s right.  My friends knew I was going into labor because I threatened to kill people.  For one of my besties, it’s when she’s about to start her period.  Yes, that’s right.  PMS.  Three letters that strike fear in the hearts of husbands everywhere.  It’s what teenage boys use to blame girls for having any strong opinions.  “She told me I was out of line.  She must have PMS.”  Premenstrual Syndrome is like the government.  Everyone thinks they know how the country should be run but they have no idea how government works.  So with PMS.  They think they know what it is and what we should “do to fix it” but in reality for most it is a mystery.

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Does PMS exist? Why of course.  You see, your brain is a wonderfully strange organ.  Besides keeping you alive everyday by making sure you can breathe and swallow and move in an organized fashion, your brain is your regulatory system for your emotions, your thoughts and even your hormones.  Oh we’d like to blame our ovaries for everything, but it’s the brain that drives your body to work in the way it does.  For women, our brain is constantly “talking” to our reproductive organs, sending pulses of hormones trying to get them to spit out hormones in the hopes of getting us pregnant (no thank you).  That results in a lot of peaks and valleys throughout the menstrual cycle.  I like to tell my patients that for some women it’s like a horrible roller coaster and no one will let those bars up so you can get off the ride!  Some women have such bad symptoms that they are classified with premenstrual dysphoric disorder (PMDD) based on what poor quality of life they have during this time in their cycle.  Ouch!

So what is my response when usually well meaning spouses and significant others ask me to “fix” my patients PMS?  Usually I start with (surprise) my strong feelings about understanding what it means to be the sex that was created to carry and deliver another human being.  Give us a break.  They also give us the ability to bond with tiny humans that scream at us the moment they are born, they give us the ability to feed that tiny screaming human from our own body if we choose to do so.  Those same hormones are probably a big reason my bestie tolerates her husband who inspired this blog post with his eye rolling PMS commentary!  The truth is there aren’t a lot of options for treatment of PMS, especially if symptoms are severe.  While there is a lot of money to be made fixing erectile dysfunction, curing premenstrual syndrome just isn’t a sexy sell.  Fortunately for many women starting on a birth control pill, taking scheduled NSAID medications or even using medications to treat other disorders like depression and anxiety can help with PMS.

In the mean time, get over it. period.  Stop using PMS as an excuse for anybody like me who has lots of opinions and strong feelings.  I would never accuse Pastor Jason of having something like PMS if KD leaves OKC and he spends hours sobbing uncontrollably.  I choose not to buy into the belief that opinions and strong feelings are all bad.  Strong feelings get things done.  I hope my passion for the “important things” will be the reason we eliminate cervical cancer or domestic violence or sexual assault.  I’m sure my passion for the “not important” things keeps the church girls entertained on a daily basis.

So ladies, keep your strong feelings.  Make time for self care, even if you don’t have PMS.  Husbands, boyfriends, friends, significant others, partners, give grace to those around you.  It might be PMS.  It might be lack of food, lack of sleep, a looming deadline or some other stressor.  If you have terrible PMS talk to a physician you trust.  Hopefully you can find relief.  But most of all, give yourself some grace.  I won’t say that I have never regretted sharing my opinions or having strong feelings about something.  I am certain that a lot of my opinions are probably not correct or based on anything sound.  My opinions on lots of things have changed over time and are probably just as strong in the opposite direction of what I once thought.  And I probably won’t ever stop with the “don’t help me, I know best, here are my strong feelings” during those times of mental fatigue.  And maybe neither will you.  No apology needed.  I’m over it.  Period.